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Colonic diverticulitis is a common intestinal disease which affects the large intestine or colon and tissues surrounding the colon. Diverticulitis is formed by diverticulosis, which is a medical condition in which there is formation of pouches. These are medically termed as diverticula on the outer surface of large intestine or colon. Pouches or diverticula may become inflamed and consequently cause severe pain and risk of infection to the patient involved.
Commonly associated symptoms of Colonic diverticulitis can be as follows,
- Fever
- Abnormal increase in the white blood cell count in blood commonly detected by conducting blood sample tests. This condition can be medically referred as leukocytosis.
- Patient suffering from colonic diverticulitis may experience acute pain in the right abdomen.
- Nausea, constipation, cramping of muscles, diarrhea
Etiology of Colonic diverticulitis can be as follows,
- Main cause of colonic diverticulitis is increase of pressure within the colon which causes bulging of pockets of tissues commonly referred as sacs. This bulging of sac is called as diverticulum.
- If there is more than one diverticulum it is referred as diverticula
- These diverticula can occur throughout the colon, but mostly found near end of left colon and is medically referred to as sigmoid colon
- Condition of development of diverticula in colon or large intestine is referred as colonic diverticulosis
- Person who suffers from consequences of Colonic diverticulitis is referred to having diverticular disease.
Diagnosis of Colonic diverticulitis: Diagnosis of colonic diverticulitis can be carried out with the help of CT scan (computerized tomography) of colon or large intestine. CT scan is very accurate in detecting and diagnosing Colonic diverticulitis. For obtaining highly accurate information about the patient involved, a thin section about 5mm is size, transverse images are collected throughout the entire abdominal section and pelvis region. For achieving this, the patient involved has to be administered with oral as well as intravascular contrast medication.
Images obtained through CT scan can reveal very important information about patient colonic condition which may include, localized thickening or inflammation of the colonic wall It can also detect increased blood flow to this affected section. Inflammation can extend to fatty tissues surrounding colon. Apart from CT scan, barium enema and colonoscopy can be employed for the diagnosis of colonic diverticulitis, but these techniques are employed depending upon the patient's condition during emergency. In advanced phases of colonic diverticulitis characterized by acute pain, these techniques are not used as it involves risk of more perforation of the colon.
Diagnosis is employed to keeping in mind possibility of colon cancer, inflammatory bowel disease, ischemic colitis, and also irritable bowel syndrome; these can be accompanied by several urological and gynecological processes.
Treatment of Colonic diverticulitis
Simple and uncomplicated cases of colonic diverticulitis can be treated by employing conservative therapy with the help of bowel rest and use of antibiotics. While in cases which are recurring in nature associated with complications, such as peritonitis, abscess or fistula may require surgical intervention which can be immediately carried out or deferred by certain duration. Such treatment is totally governed by condition of patient and severity of symptoms. Special care is taken regarding diet of the patient, and is typically placed on low fiber diet, to prevent colon from getting overloaded. This helps the colon to heal properly. After this, subsequently the patient is placed on a high fiber diet.
Surgical Intervention: It can be immediate in case of medical emergency or voluntary admission. Voluntary surgical intervention may be carried out considering the factors including stage of the disease, patient's age, patient's medical condition, severity and frequency of recurring problem in the patient. A typical voluntary surgery can be carried out after six weeks of recovery from acute diverticulitis.
Medical emergency in Colonic diverticulitis is characterized by rupture of walls of the intestine. This rupture results in subsequent infection in the abdominal cavity. During a typical Colonic diverticulitis surgery, the ruptured section of intestine is removed. This is followed by colostomy wherein the surgeon operating the patient creates an opening between the large intestine or colon and surface of skin. A typical time frame required to close a colostomy is 10 to 12 weeks characterized by a subsequent surgery in which cut end of the colon or large intestine are rejoined.
Colonic diverticulitis surgery can be carried out by two methods of surgery: primary bowel resection and bowel resection with colostomy. Both the bowel resections may be carried out by traditional method or by laparoscopic surgery.
Primary bowel resection: Primary bowel resection is standard procedure employed in the treatment of Colonic diverticulitis. It employs removal of ruptured or damaged portion of large intestine subsequently reconnecting healthy portion of the large intestine. This process is defined as anastomosis. Depending upon the patient's general medical condition, traditional method or laparoscopic surgery characterized by smaller incisions and faster recovery may be employed.
Bowel resection with colostomy: Presence of excess inflammation in case of Colonic diverticulitis renders primary bowel resection potentially risky. In this case, bowel resection with colostomy is utilized for the treatment of Colonic diverticulitis. This surgery is also referred to as Hartmann's operation, which is a more advanced surgery which is complicated in nature. This surgery is typically employed in life threatening conditions. This surgery employs temporary colostomy which is followed by second surgery whose purpose is reverse of the first surgery in treatment of Colonic diverticulitis. In this case, the surgeon operating on the patient makes a small incision to make a small opening in the patient's abdominal wall for efficient removal of infection and inflammation. The large intestine or colon is taken out through the opening and all the waste comprising of infection and inflammation is collected in the bag. A typical colostomy is temporary but may be permanent depending upon the patient's condition and severity. Typically, after a predefined passage of time, leading to the healing of inflammation, another major surgery is carried out, which is characterized by rejoining of colon and rectum which consequently reverses a colostomy.
Colonic diverticulitis is found in middle aged, elder persons and rarely younger people. Do observe and follow up with medical care if you see suspect colonic diverticulitis.
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